Abstract

OBJECTIVES: There is considerable interest in the potential for harmonizing health technology assessments (HTA) across jurisdictions. This study aims to consider four HTAs of drug eluting stents to determine the degree to which the methods adopted, evidence considered, and resulting recommendations diverge.

METHODS: Four HTAs of drug eluting stents were selected for inclusion and evaluated using a framework developed to systematically capture information on the process adopted, the evidence considered and the recommendations of each HTA.

RESULTS AND CONCLUSIONS: The findings suggest that, although there is a common core data set considered by most of the agencies, differences in the approach to HTA, heterogeneity of studies, and the limited relevance of research findings to local practice meant that the core data set had only limited influence on the resulting recommendations. Of the HTA agencies considered in the analysis, many sought to generate additional primary research from local settings to help inform the development of recommendations that were relevant to local practice. This raises questions about the extent to which HTA methods can be harmonized across jurisdictions.

Abstract

No abstract available.

Abstract

BACKGROUND: Those working in psychiatric units care for some of the most vulnerable and needy patients within health services, and suffer some of the highest levels of job dissatisfaction and burnout within healthcare workforce. Poor staff morale is bad for patient care and is economically wasteful. The same level of evidence of effectiveness and efficiency should be considered in workforce planning as is required in patient care. This has hitherto not occurred.

AIM: To examine the impact and cost effectiveness of strategies to improve staff morale and reduce "burnout" amongst staff working in psychiatric units.

METHODS: We conducted a systematic review of robust evaluations of strategies designed to improve psychological wellbeing or the working experience of staff working in psychiatric units. We searched the following databases: EMBASE; MEDLINE; PsycINFO; CINAHL; Sociological Abstracts; HMIC; Management and Marketing Abstracts; Management Contents and Inside Conferences (all to 2004), and sought the following outcomes: Psychological wellbeing; Job satisfaction; staff burnout and stress; staff sickness and turnover; Direct and indirect costs. The following designs were included: Randomised Controlled Trails (RCTs); Controlled Clinical Trials (CCTs); Controlled Before and after studies (CBAs); and interrupted time series (ITSs). We conducted a narrative overview of key design features, endpoints and results.

RESULTS: We identified eight evaluations of strategies to improve staff morale (3 RCTs; 3 CCTs and 2 CBAs). Educational interventions designed to enhance the skill and competency of staff were the most commonly evaluated, and showed positive impact on at least one outcome of interest. Psycho-social interventions that sought out members of staff who were experiencing emotional problems and offered work-based support and enhanced social support networks were positive in US healthcare settings, but had been incompletely implemented and evaluated in UK settings. Organisational interventions, such as a shift to continuous care and primary nursing also showed a potential to be effective in reducing sickness rates and improving job satisfaction.

CONCLUSIONS:There is substantial opportunity to design and implement interventions to improve the working experience of staff in psychiatric units. There is an onus to evaluate the longer term impact and cost effectiveness of these strategies. Unfortunately strategies are currently being implemented in the absence of any prospective evaluation.

Abstract

Interventions for drug-using offenders are employed internationally to reduce subsequent drug use and criminal behavior. This paper provides information from a systematic review of 24 randomized controlled trials (RCTs) conducted between 1980 and 2004. Thirteen of the 24 trials were included in a series of meta-analyses, and tentative conclusions are drawn on the basis of the evidence. Pretrial release with drugs testing and intensive supervision were shown to have limited success when compared to routine parole and probation, with effect sizes favoring routine parole and probation. Therapeutic community interventions showed promising results when compared to dispensation of treatment to individuals as usual, reducing risk of future offending behavior. A few studies evaluated the effectiveness of assertive case management and other community-based programs, but due to the paucity of information few inferences could be drawn from these studies. Little is known about the cost and cost effectiveness of such interventions, and the development of established protocols is required.

Abstract

We estimated the incidence and cost of accidental falls for the population with visual impairment, and the incidence and cost of falls directly attributable to visual impairment for the UK in 1999. Methods: A prevalence-based cost model of medical care was developed using national data for Accident and Emergency (A&E) attendances and hospital inpatient admissions. The population with visual impairment was based on the age-specific prevalence rates of visual impairment. The number of falls directly attributable to visual impairment was estimated from the relative risk of falls for visual impairment reported in the literature. The number of health service resource events in each age group (0-14, 15-64, 65-74, and 75+ years) was multiplied by the respective cost of each event. Results: There were over 2.35 million accidental falls in the UK that required hospital treatment in 1999. Of these falls, 189,000 occurred in individuals with visual impairment, of which 89,500 can be attributed to the visual impairment itself. The estimated medical costs of these falls were £269 m (range: £193 m - £360 m) and £128 m (range: £32 m - £240 m), respectively. Eighty-nine percent of these falls and the majority of costs occurred in those aged 75 years and over. Results were most sensitive to the relative risks of falls and the proportion of long-term care costs attributed to the fall. Conclusions: Of the total cost of treating all accidental falls in the UK, 21% was spent on the population with visual impairment and 10% was directly attributable to visual impairment.

Abstract

OBJECTIVES: The overall objective of this study was to estimate the costs and outcomes associated with treatment with valsartan for post-myocardial infarction (post-MI) patients with left ventricular systolic dysfunction, heart failure, or both, who are not suitable for treatment with angiotensin-converting enzyme (ACE) inhibitors, compared to placebo.

METHODS: A Markov model, using data drawn from the Valsartan in Acute Myocardial Infarction (VALIANT) trial and other trials, was developed to predict the future health pathways, resource use, and costs for patients who have recently experienced an MI. Patients received either valsartan (mean dose 247 mg) or placebo. Cost data were drawn from national databases and published literature, although health outcome utility weights were derived from existing studies. Patient outcomes were modeled for 10 years, and incremental cost-effective ratios were calculated for valsartan compared with placebo.

RESULTS: Over a period of 10 years, a cohort of 1000 patients treated with valsartan experienced 147 fewer cardiovascular deaths, 37 fewer nonfatal MIs, and 95 fewer cases of heart failure than a cohort who received placebo. The incremental cost of valsartan, compared with placebo, was 2680 pound per patient, although the incremental effectiveness of valsartan was 0.5021 quality-adjusted life-years (QALYs) gained per patient. Therefore, the incremental cost per QALY for treatment with valsartan was 5338 pound. When analysis was undertaken using life-years rather than QALYs, the cost per life-year gained was 4672 pound.

CONCLUSIONS: For patients who are not suitable for treatment with ACE inhibitors, valsartan is a viable and cost-effective treatment for their management after an MI.

Abstract

Identifying information to inform patient care decisions can be straightforward if you know the important key resources. In recent years the NHS has invested in services that collate evidence and identify the messages from research. You can use these to help make patient care more evidence-based and to reduce health inequalities. This article describes some of the key resources you can use to inform life-long learning and to answer day-to-day clinical queries.